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General NPI Number Information
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NPI Number | 1861259004
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Entity Type | Organization
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Legal Business Name | HUMAN WELLNESS LLC
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 580 BROADWAY ST STE 301
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-4328
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Country | US
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Telephone | 949-342-6011
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Fax |
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Provider Business Mailing Address
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Address Line | 30025 ALICIA PKWY # 635
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-2090
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Country | US
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Telephone | 949-342-6011
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. COURTNEY M TRACY
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Credential | LCSW, PSYD
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Telephone | 949-342-6011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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